Weekly Influenza & Respiratory Illness Activity Report A summary of influenza surveillance indicators prepared by the Division of Infectious Disease Epidemiology Prevention & Control Week Ending March 9, 219 WEEK 1 All data are preliminary and may change as more information is received Minnesota Influenza Geographic Spread No Activity Sporadic Local Regional Widespread During the week ending March 9, 219 (Week 1), surveillance indicators showed widespread geographic spread of influenza (based on CDC s Activity Estimates Definitions). Since the start of the influenza season, no pediatric influenza-related deaths have been reported. Minnesota Influenza Surveillance (http://www.health.state.mn.us/divs/idepc/diseases/flu/stats/) Weekly U.S. Influenza Surveillance Report (http://www.cdc.gov/flu/weekly/) World Health Organization (WHO) Surveillance (http://www.who.int/influenza/surveillance_monitoring/updates/en/) Neighboring states influenza information: Iowa: Iowa Flu Reports (http://idph.iowa.gov/influenza/reports) Wisconsin: Influenza (Flu) (http://www.dhs.wisconsin.gov/communicable/influenza/) North Dakota: Reported Seasonal Influenza Activity in North Dakota (http://www.ndflu.com/default.aspx) South Dakota: South Dakota Influenza Information (http://doh.sd.gov/diseases/infectious/flu/) Minnesota Department of Health 651-21-5414 or 1-877-676-5414 www.health.state.mn.us 3/14/219
Hospitalized Influenza Surveillance Hospitalized influenza cases are based on disease reports of laboratory-positive influenza (via DFA, IFA, viral culture, EIA, rapid test, paired serological tests or RT-PCR) and specimens from hospitalized patients with acute respiratory illness submitted to MDH-PHL by hospitals and laboratories. Due to the need to confirm reports and reporting delays, consider current week data preliminary. Hospitalized Influenza Cases by Type Minnesota (FluSurv-NET*) Hospitalized Influenza Cases by Season, Minnesota (FluSurv-NET*) 275 2 225 175 125 75 25 B (no genotype) B (Yamagata) B (Victoria) A (not subtyped) A H3 A H1 (unspecified) A (H1N1)pdm9 A (H1N2v) A (H3N2v) A&B 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Hospitalizations this week Unknown *Influenza Surveillance Network Hospitalizations last week Total hospitalizations (to date) 24 199 1,478 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 2 7 7 6 6 5 4 4 3 2 213-14 214-15 215-16 216-17 217-18 218-19 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Season Total hospitalizations (historic) 213-214 1,578 214-215 4,81 215-216 1,538 216-217 3,695 217-218 6,446 218-219 1,478 (to date)
Hospitalized Influenza Surveillance (continued) Number of Influenza Hospitalizations and Incidence by Region, Minnesota September 3, 218 March 9, 219 Number of Influenza Hospitalizations and Incidence by Age, Minnesota September 3, 218 March 9, 219 8 6 4 22.7 Region 25.3 34.5 21.4 Region 34.1 35.3 Hospitalizations this week # of hospitalizations Incidence (cases) per, Persons 24.8 26.2 Total (to date). 8. 6. 4. 2.. Hospitalizations per, Persons Central 21 (1%) 17 (12%) Metro 123 (6%) 768 (52%) 6. Northeast 13 (6%) 112 (8%) Northwest (%) 34 (2%) South Central 17 (8%) 99 (7%) Southeast 17 (8%) 178 (12%) Southwest 1 (.5%) 54 (4%) West Central 12 (6%) 63 (4%) Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 3 8 6 4 38.3 # of hospitalizations Incidence (cases) per, Persons 6.5 15.5 33.4 72.2-4 5-24 25-49 -64 65+ Age Group (years) Median age (years) at time of admission. 8. 6. 4. 2.. Hospitalizations per, Persons
Influenza-Associated Death Surveillance Influenza deaths are collected via reports from Minnesota s death certificate database, hospitals, and long-term care facilities. Decedents with influenza listed as a cause of or contributor to death, have recent laboratory confirmation of influenza, or are part of an ongoing influenza outbreak at a long-term care facility are reported to influenza surveillance. Due to the need to confirm reports and reporting delays, consider current week data preliminary. Deaths Associated with Influenza by Season, Minnesota Deaths Associated with Influenza by Age Group and Season, Minnesota 7 6 4 3 2 213-14 214-15 215-16 216-17 217-18 218-19 Number of Deaths 2 213-14 214-15 215-16 216-17 217-18 218-19 1 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Season Total deaths Total pediatric (<18 years) deaths (historic) (historic) 213-214 83 2 214-215 368 1 215-216 76 3 216-217 273 2 217-218 435 5 218-219 39 (to date) (to date) *Influenza Surveillance Network Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 4 Season -17 18-49 -64 65-79 8+ Age Group (years) Median age (years) at time of death 213-214 63 214-215 85 215-216 68 216-217 86 217-218 85 218-219 72. (to date)
Respiratory Disease Outbreak Surveillance School Outbreaks K-12 schools report an outbreak of influenza-like illness (ILI) when the number of students absent with ILI reaches 5% of total enrollment or three or more students with ILI are absent from the same elementary classroom. Influenza-like Illness (ILI) in Schools by Season Number of Influenza-like Illness Outbreaks 2 213-14 214-15 215-16 216-17 217-18 218-19 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 New school outbreaks this week New school outbreaks last week Total this season (to date) 42 29 263 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 5
Respiratory Disease Outbreak Surveillance (continued) Long-Term Care (LTC) Outbreaks LTC facilities report to MDH when they suspect an outbreak of influenza in their facility. Laboratory-confirmed outbreaks are reported here. Confirmed Influenza Outbreaks in LTC by Season Number of lab-confirmed outbreaks 45 4 35 3 25 2 15 1 213-14 214-15 215-16 216-17 217-18 218-19 5 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 21 New LTC outbreaks this week New LTC outbreaks last week Total this season (to date) 5 6 35 Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 6
Sentinel Provider Surveillance (Outpatients) MDH collaborates with healthcare providers who report the total number of patients seen and the total number of those patients presenting to outpatient clinics with influenza-like illness. Percentage of Persons Presenting to Outpatient Clinics with Influenza-Like Illness (ILI) Percent with Influenza-like Illness 9 8 7 6 5 4 3 2 * 213-14 214-15 215-16 216-17 217-18 218-19 1 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 % of outpatients with ILI this week % of outpatients with ILI last week 3.1% 2.8% * Indicates current week-data may be delayed by 1 or more weeks Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 7
Laboratory Surveillance The MN Lab System (MLS) Laboratory Influenza Surveillance Program is made up of more than 31 clinic- and hospital-based laboratories, voluntarily submitting testing data weekly. These laboratories perform rapid testing for influenza and Respiratory Syncytial Virus (RSV). Significantly fewer labs perform PCR testing for influenza and three also perform PCR testing for other respiratory viruses. MDH-PHL provides further characterization of submitted influenza isolates to determine the hemagglutinin serotype to indicate vaccine coverage. Tracking the laboratory results assists healthcare providers with patient diagnosis of influenza-like illness and provides an indicator of the progression of the influenza season as well as prevalence of disease in the community. Specimens Positive for Influenza by Molecular Testing*, by Week Number of Positive Molecular Tests 8 7 7 6 6 5 4 4 3 2 B A (not subtyped) A H3 A (H1N1) pdm9 214-15 % + by PCR 215-16 % + by PCR 216-17 % + by PCR 217-18 % + by PCR 218-19 % + by PCR 4 41 42 43 44 45 46 47 48 49 51 52 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 35 3 25 2 15 1 5 Percent of Positive Molecular Tests % molecular tests positive this week % molecular tests positive last week 26.7% 25.6% * Beginning in 216-17, laboratories report results for rapid molecular influenza tests in addition to RT-PCR results Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 8
Laboratory Surveillance (continued) MLS Laboratories Influenza Testing Specimens Positive by Influenza Rapid Antigen Test, by Week MLS Laboratories RSV Testing Specimens Positive by RSV Rapid Antigen Test, by Week Number of Positive Influenza Specimens 9 8 7 6 4 B+ (218-19 Season) A+ (218-19 Season) A/B+ (218-19 Season) 214-15% + 215-16 % + 216-17 % + 217-18% + 218-19% + 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 45 4 35 3 25 2 15 1 5 Percentage of Rapid Antigen Influenza Tests Positive Number of Positive RSV Tests 225 175 125 75 25 Number + 214-15 % + 215-16 % + 216-17 % + 217-18 % + 218-19 % + 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 9 8 7 6 4 3 2 1 Region % rapid antigen influenza tests + (current week) Northeast 35% South Central 27% Southwest 26% Southeast 42% Metro 31% Central 29% West Central 29% Northwest 71% State (overall) 32% Region % rapid antigen RSV tests + (current week) Northeast 2% South Central 53% Southwest 5% Southeast 18% Metro 17% Central 26% West Central 26% Northwest 44% State (overall) 21% Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 9
Hospitalized RSV Surveillance Surveillance for respiratory syncytial virus (RSV) began in September 216. Hospitalized inpatients of all ages who reside in the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington) with laboratory-confirmed RSV are reportable. Due to the need to confirm reports and reporting delays, consider current week data preliminary. 9 8 7 6 4 3 2 1 4 42 44 46 48 52 2 4 6 8 1 12 14 16 18 2 Hospitalizations this week Hospitalized RSV Cases by Subtype, Minnesota Hospitalizations last week RSV A RSV B RSV, Unspecified Total hospitalizations 4 14 87 Number of RSV Hospitalizations and Incidence by Age, Minnesota 6 4 349. 34. 2.9.8 2.4 1. <2 2-4 5-17 18-49 -64 65+ Age Group (years) # of hospitalizations Incidence (cases) per, Persons Median age at time of admission 1 months 4. 3.. 2...... Hospitalizations per, Persons Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 1
Weekly U.S. Influenza Surveillance Report 218-219 Influenza Season Week 9 ending March 2, 219 CDC National Influenza Surveillance (http://www.cdc.gov/flu/weekly/) Influenza activity remains elevated in the United States. Viral Surveillance :The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories increased slightly. Nationally, during week 9, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm9 viruses. During the most recent three weeks, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm9 viruses in HHS Regions 2, 4, 6, 7 and 8. Influenza-like Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) decreased slightly to 4.7%, which is above the national baseline of 2.2%. All 1 regions reported ILI at or above their region-specific baseline level. ILI State Activity Indictor Map: 32 states experienced high ILI activity; Puerto Rico and seven states experienced moderate ILI activity; New York City, the District of Columbia and eight states experienced low ILI activity; three states experienced minimal ILI activity; and the U.S. Virgin Islands had insufficient data. Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 48 states was reported as widespread; the District of Columbia and two states reported local activity; the U.S. Virgin Islands reported sporadic activity; and Guam did not report. Influenza-associated Hospitalizations A cumulative rate of 36.6 laboratory-confirmed influenza-associated hospitalizations per, population was reported. The highest hospitalization rate is among adults 65 years and older (17.7 hospitalizations per, population). Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System. Influenza-associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported to CDC during week 9. Eight deaths occurred during the 218-219 season and one death occurred during the 215-216 season. A Weekly Influenza Surveillance Report Prepared by the Influenza Division Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists* A Weekly Influenza Surveillance Report Prepared by the Influenza Division Influenza-Like Illness (ILI) Activity Level Indicator Determined by Data Reported to ILINet *This map indicates geographic spread and does not measure the severity of influenza activity. Minnesota Department of Health Weekly Influenza & Respiratory Activity Report for Week Ending March 9, 219 WEEK 1 11